Case Study 1: Sharon
This case study is from Chapter 12 of the Personal Trainer Manual on page 412-418.
Sharon is a 33-year-old female who works from home and has two children under the age of four. Prior to her pregnancies, Sharon was a recreational runner who ran two to three times a week to train for 5K and 10K races and played on a coed soccer team for fun on the weekends. Sharon also worked out in a health club doing group strength training and group indoor cycling classes to stay in shape for her activities, but rarely worked out on her own because she preferred the camaraderie of group activities. She was a high school and Division III college soccer player.
Sharon exercised during both pregnancies, continuing the group strength training classes, but replacing the running with prenatal yoga classes and walking. Now that both kids are a little older and can be left with a babysitter during her workouts (her youngest child is 12 months old), Sharon wants to work with a personal trainer to start working out regularly and get back in her pre-pregnancy shape.
Sharon has approached Mike, a trainer at her health club, about using his services. Mike led Sharon’s introductory sessions when she joined the club three years ago, and he has continued to talk with her and ask about her family, so there is existing rapport. Sharon decides that she will invest in a package of 20 personal-training sessions in an effort to return to her pre-pregnancy fitness level. Mike sets the first appointment with Sharon so he can update her health-history information, measure her blood pressure, identify her specific training goals, and have her start on a basic exercise program. The health history reveals that other than her recent pregnancies and a knee sprain suffered while playing soccer in college, Sharon has no medical issues, but she does indicate that she has been experiencing mild soreness in her low back since the birth of her second child, though it has never been severe enough for her to seek the attention of a doctor (Table 12-1).
Sharon identifies her goals as returning to her pre-baby bodyweight and resuming her pre-pregnancy fitness activities, such as running and group strength training classes. Sharon is not concerned about her back, but is aware that she has lost core strength since her recent pregnancy and cites that as the cause of the soreness. In their discussion, Mike learns that the only concern Sharon has about her exercise program is that she will need to work around her childcare and work schedules and might not be able to make it to the club for every workout. Therefore, she wants a routine that she can do on her own with the stability ball, medicine ball, and dumbbells she has at home.
Based on the health-risk appraisal and the goal-setting discussion, Mike determines that Sharon is in the preparation stage of change because she is motivated to exercise regularly, but has yet to adopt a regular routine. Mike notes that she has the potential to move fairly quickly into the action stage because she is motivated to exercise, has been successful at following a regular exercise program in the past, and just needs structure for a proper training progression to achieve her goals. Upon the conclusion of the health history and blood-pressure assessments, Mike conducts a basic assessment of her posture to identify any major muscle imbalances and finds slight thoracic kyphosis and increased low-back lordosis. He decides to spend the last 20 minutes of the first session teaching Sharon basic core-activation exercises, including the birddog, plank, sideplank, and glute bridge exercises so that she can start working on her core stability.
Sharon is a highly motivated ex-athlete who wants to include running as a mode of exercise, but she has not been exercising regularly since before the birth of her second child. Mike will first implement a cardio-respiratory program that helps her rebuild her aerobic base. Once she can complete 20 to 30 minutes of steadystate moderate-intensity exercise in zone 1 [ratings of perceived exertion (RPE) of 3 to 4], he will have her perform a submaximal talk test to establish her heart rate at the first ventilatory threshold (VT1). He will then use her heart rate at VT1 to progress her cardiorespiratory program to help her work toward her running goals.
Mike determines that he will assess Sharon’s lower-body flexibility and test the strength and endurance of her core muscles in an effort to identify the cause of her low-back discomfort. During the second session, Mike will conduct the passive straight-leg raise assessment and the Thomas test, along with the trunk flexor, trunk lateral, and trunk extensor endurance tests, in an effort to identify any abnormal muscle tightness or weakness that can be addressed with the exercise program. Mike will use the results from these assessments to establish Sharon’s baseline levels of flexibility and core strength for comparison with futureassessments to determine program effectiveness. In their initial conversation, Sharon identifies her primary objective as weight loss and indicates that she is motivated by tracking her results, so Mike decides to take body composition and circumference measurements so they can track progress toward her goals. During the assessments, Sharon was able to complete all of the fitness tests without complications. Rather than compare her scores to “norms,” Mike decides to simply record Sharon’s scores to use as baseline values when measuring progress during future assessments, and to help with program design. Table 12-2 presents Mike’s notes.
Functional Movement and Resistance Training—Phase 1: Stability and Mobility Training
Due to the imbalances in flexibility and muscular strength and endurance, Mike will start Sharon with a program focusing on stability and mobility. This phase will last until Sharon demonstrates effective strength of the core muscles and improved range of motion (ROM) of the hips. Mike estimates that Sharon will spend two to four weeks in this phase.
• Frequency: Sharon will train two times per week with Mike and once a week on her own.
• Intensity: These exercises focus on using bodyweight to create an overload, leading to enhanced conditioning and stability of the core muscles.
• Type: Based on her goals and the results of the assessments, Mike designs a program that will focus on exercises to help improve her core strength while also addressing the ROM of her hips.
• Time: Each workout should last approximately one hour, including a five-minute warm-up of walking on the treadmill and a 10-minute cool-down that includes stretching of the hip flexors, adductors, and extensors, as well as the back, chest, and calves.
Table 12-3 presents Sharon’s initial functional- movement program, which is designed to improve core stability and mobility. She will start with two sets of each exercise, with rest intervals of 60 seconds. As Sharon adapts to the exercises and progresses through the training program, Mike will increase the volume to three sets of each exercise and minimize the rest intervals so that Sharon begins to do all of the exercises in a circuit format, moving from one exercise to the next and not resting until the end of the series of exercises. Mike will teach Sharon how to do a modified version of the workout with the equipment that she has available at home.
Once Sharon is able to complete the exercise circuit three to four times with good coordination and while maintaining a high work rate, Mike will change the exercise selection and progress the resistance-training workout into the movement-training phase (phase 2).
Cardiorespiratory Training— Phase 1: Aerobic-base Training
During this phase, Sharon will train at an aerobic level that falls below the “talk test” level. Since VT1 will not be assessed until the next phase, Mike will teach her how to gauge her intensity using the RPE scale (0 to 10 scale), and instruct her to exercise at an RPE of 3 to 4, with initial goals of performing regular cardiorespiratory exercise while focusing on increased duration. Mike will plan three aerobic-training sessions per week during this phase of training. Since Sharon wants to get back into running, Mike will start her with a program built on brisk walking and then introduce jogging into her cardiorespiratory training. This also meets her requirement of being able to exercise on her own by going outside for walks or runs when she does not have time to make it to the health club. Table 12-4 presents Sharon’s aerobic-base training program.
Once Sharon is consistently performing 25 to 30 minutes of walking/jogging at an RPE of 4 and is ready to do more, Mike will have her perform a submaximal talk test to determine her HR at VT1 and then progress her program by introducing low–zone 2 intervals with intensities slightly above VT1.
Functional Movement and Resistance Training— Phase 2: Movement Training
This phase will last until Sharon demonstrates effective and efficient control of the basic movement patterns: squatting, lunging, pushing, pulling, and rotational (see page 330 for more information on the five basic movement patterns). Mike estimates that Sharon will spend four to six weeks in this phase
• Frequency: Sharon will train twice per week with Mike and once a week on her own.
• Intensity: These exercises primarily use bodyweight as resistance, but Sharon can progress to using external-resistance equipment like medicine balls and dumbbells as her movement patterns and strength improve.
• Type: The focus of the exercise selection is to retrain basic patterns of movement and work on integrated muscle coordination.
• Time: Each workout should last approximately one hour, including the warm-up and cool-down. Table 12-5 presents Sharon’s movement training program.
Cardiorespiratory Training— Phase 2: Aerobic-efficiency Training
Mike has Sharon perform a submaximal talk test and determines her HR at VT1 to be 140 bpm. Mike continues to recommend three zone 1 cardiorespiratory sessions per week during this phase of training, but will modify the workouts to all running that progresses to include zone 2 intervals that have Sharon exercising at, or just above, her HR at VT1 (approximately 140 to 150 bpm), with adequate recovery intervals to build aerobic efficiency. Sharon has been enjoying the workouts and has invested in a heart-rate monitor so she can track her intensity more efficiently. Table 12-6 presents Sharon’s aerobic efficiency program.
Once Sharon demonstrates the proper coordination, strength, and control through the basic movement patterns, Mike can increase the intensity of her training so that she progresses to phase 3 (load training), at which point she can focus on training for muscular strength. Sharon has lost weight and is on the way to achieving her goal of regaining her pre-pregnancy fitness level. She now wants to work on increasing her strength so that she can do full-body pull-ups like she could in college. The next stage of program design will focus on helping Sharon gain the necessary strength to complete three full-body pull-ups while also emphasizing muscular definition.
Functional Movement and Resistance Training—Phase 3: Load Training
Sharon will continue in this phase until she reaches her goal of completing three bodyweight pull-ups. Once that goal is achieved, she and Mike will establish new goals.
• Frequency: Sharon is now working with Mike only once a week and is able to train twice a week on her own.
• Intensity: Mike sets the intensity to achieve strength and advises Sharon that she should fatigue by the twelfth repetition of each set. If not, she should increase the resistance.
• Type: The focus of the exercise selection is on compound movements that create integrated, total-body strength.
• Time: Each workout should last approximately one hour, including the warm-up and cool-down. Table 12-7 presents Sharon’s load-training program.
Cardiorespiratory Training— Phase 2: Aerobic-efficiency Training (Progression)
The goal of this phase of Sharon’s program is to perform aerobic intervals for improving aerobic efficiency. In this phase, Sharon will progress her cardiorespiratory training to prepare for an upcoming 5K (3.1 mile) run. Mike will continue to recommend three runs per week during this phase of training, progressing to include intervals of different intensities. Mike reassesses Sharon’s HR at VT1 by having her perform another submaximal talk test. Her new HR at VT1 is 144 bpm, which Mike uses as an intensity marker for her work intervals. Sharon has been enjoying the workouts and uses her heart-rate monitor to track her intensity and work rate. To reduce her risk of repetitive-stress injuries from running, Sharon plans on varying her cardiorespiratory workouts by replacing one day of running per week with an indoor cycling class. Sharon has consistently worn her heart-rate monitor during training and feels that it helps her track her progress and improves her consistency with following her exercise routine. Table 12-8 presents Sharon’s new cardiorespiratory training program.